Towards a shared agenda for EU reform

UIDB/04627/2020 UIDP/04627/2020Relations between southern European member states have often been marked by a loose cooperation or, worse, by logics of competition. Precisely when regional groupings within the EU are increasingly shaping the agenda, these dynamics have hindered the capacity of France, Greece, Italy, Portugal and Spain to pursue shared interests and objectives, while acting as a force for good for the European integration project. Recent events such as the post-pandemic recovery or the war in Ukraine show that, when cooperation occurs, positive results can be achieved. Southern member states can capitalise on a certain ideological affinity and a pro-European vision, despite their governments belonging to different political groups. They share converging interests in the areas of fiscal policy and economic governance, strategic autonomy in energy and technology and even foreign policy priorities, particularly towards the Mediterranean and relations with other global powers. This joint publication by six southern European think tanks identifies several policy areas for fruitful cooperation between southern European member states.publishersversionpublishe

integrated care for complex chronic patients

Background: In 2006, 35% - 40% of the population in the EU aged > 65 years reported a longstanding health problem and one in four currently receives medical long-term treatment. In Catalonia, data from the 2011-2015 health plan reported that about 30% of the general population has at least one chronic disorder. It is widely accepted that this increasingly important group of the population may suffer frequent unexpected hospital admissions or emergency room visits because of clinical or social circumstances triggering adverse outcomes. Accordingly, the Complex Chronic Patient (CCP) is defined as a patient with at least one+ chronic diseases, comorbidities, frail (due to social, economic and/or clinical factors), usually elderly, and who consumes a very high level of health resources. Although CCPs comprise about 5% of the general population, their health care needs consume an estimated 40% plus of all hospital admissions. Methods: CONNECARE (H2020-PHC-2015-689802) aims to develop and evaluate a new organizational model to enable integrated care of CCPs, supported by technological solutions following an adaptive case management approach. From the CCP's perspective, different healthcare professionals are central to patients' care: the general practitioners, specialist doctors, other hospital staff, and social workers. Moreover, the carers, unpaid relatives or friends, who typically deliver the majority of care that CCPs require, are indispensable. The CONNECARE integrated care organizational model will facilitate collaboration and communication among healthcare professionals, patients and their carers through integrated technological solutions in which the patients play a central role. CONNECARE will also support and empower patients for self-management, by providing them recommendations and suggestions according to continuous monitoring of their activities. CONNECARE will be deployed in three regions: Catalonia (Spain), Israel, and Groningen (the Netherlands). Results: The CONNECARE integrated care solution is built upon the experience of on-going large-scale deployment programs in each of the participating sites and the inclusion of the main stakeholders in the process (healthcare professionals, patients, carers, insurance companies, and policy makers). Therefore, a co-design methodology has been established to capture the feed-back of all actors in the integrated care process. Three clinical studies have been defined for field-testing the CONNECARE solution that will then be performed and evaluated (October 2016 to March 2019) in the three regions: community-based management of CCP, and integrated management of patients undergoing surgical procedures with a specific use case for pre-habilitation of high risk candidates for complex abdominal surgical procedures –which will only be performed and evaluated in Barcelona. The purposes of the clinical studies are: (i) assessing health value generation of the CONNECARE solution; (ii) enabling its refinement and fine tuning during the last six-month period; and (iii) generating guidelines for transferability of CONNECARE achievements to other sites. Conclusions: The ambition of CONNECARE is to co-design, develop, deploy, and evaluate a novel integrated care services model supported by a smart and adaptive case management system for better care coordination and self-management of CCPs. Pragmatic clinical trials will be held in the three sites to assess the health value generation of the CONNECARE solution. Guidelines for the transferability of CONNECARE achievements to other sites will be developed. This will save European healthcare organizations huge sums whilst improving patient outcomes

The Impact of Spain’s Economic and Political Crisis on the European Elections. EPIN Commentaries No. 17, 2 April 2014

Despite the emergence of a critical debate against the EU-imposed austerity measures both at the level of the political elites and on the street, this EPIN Commentary by two Spanish political scientists based in Barcelona finds no sign that the upcoming European elections will have a more European focus than any of the previous ones. While there is no anti-European discourse among the Spanish mainstream political parties, they report that public trust in the European institutions is plummeting and Spanish turnout in European elections has been dropping in the last few years. In the authors’ view, the main reason for this is the low level of awareness of the functioning of the European Parliament but some responsibility also lies with the Spanish political parties and the way they deal with the electoral campaign to mobilise the discontented voters, who consider unemployment and the economic situation as the two most important issues that the country is facing at the moment

La verdad en las democracias algorítmicas

First published online: May 2020La conversación pública se ha digitalizado. La red nos ofrece un espacio horizontal y descentralizado con una superabundancia de contenidos, mientras se ha acelerado un proceso de desintermediación que ha puesto fin al monopolio de los intérpretes tradicionales de la realidad. Los universos informativos y opinativos se mezclan, confunden e hibridan nuevos contenidos. La percepción de los hechos está mediada por las emociones y las verdades son de libre elección. Esta transformación no se explica solo por la crisis de los sistemas mediáticos tradicionales, sino también por el nuevo orden algorítmico que controla en gran medida la predeterminación selectiva de la información. ¿Cómo afecta al sistema democrático que el debate público tenga lugar en espacios tecnológicos de propiedad privada? ¿Quién controla este espacio digitalizado? El verdadero desafío existencial que supone para la democracia la creación de nuevos sistemas de poder y nuevas desigualdades sociales se dirimirá en la dataficación y la gobernanza algorítmica

The critical size is set at a single-cell level by growth rate to attain homeostasis and adaptation

Budding yeast cells are assumed to trigger Start and enter the cell cycle only after they attain a critical size set by external conditions. However, arguing against deterministic models of cell size control, cell volume at Start displays great individual variability even under constant conditions. Here we show that cell size at Start is robustly set at a single-cell level by the volume growth rate in G1, which explains the observed variability. We find that this growth-rate-dependent sizer is intimately hardwired into the Start network and the Ydj1 chaperone is key for setting cell size as a function of the individual growth rate. Mathematical modelling and experimental data indicate that a growth-rate-dependent sizer is sufficient to ensure size homeostasis and, as a remarkable advantage over a rigid sizer mechanism, it reduces noise in G1 length and provides an immediate solution for size adaptation to external conditions at a population level. © 2012 Macmillan Publishers Limited. All rights reserved.Peer Reviewe

Cyclin Cln3 is retained at the ER and released by the J chaperone Ydj1 in late G1 to trigger cell cycle entry

G1 cyclin Cln3 plays a key role in linking cell growth and proliferation in budding yeast. It is generally assumed that Cln3, which is present throughout G1, accumulates passively in the nucleus until a threshold is reached to trigger cell cycle entry. We show here that Cln3 is retained bound to the ER in early G1 cells. ER retention requires binding of Cln3 to the cyclin-dependent kinase Cdc28, a fraction of which also associates to the ER. Cln3 contains a chaperone-regulatory Ji domain that counteracts Ydj1, a J chaperone essential for ER release and nuclear accumulation of Cln3 in late G1. Finally, Ydj1 is limiting for release of Cln3 and timely entry into the cell cycle. As protein synthesis and ribosome assembly rates compromise chaperone availability, we hypothesize that Ydj1 transmits growth capacity information to the cell cycle for setting efficient size/ploidy ratios

Translokin (Cep57) interacts with cyclin D1 and prevents its nuclear accumulation in quiescent fibroblasts

Nuclear accumulation of cyclin D1 due to altered trafficking or degradation is thought to contribute directly to neoplastic transformation and growth. Mechanisms of cyclin D1 localization in S phase have been studied in detail, but its control during exit from the cell cycle and quiescence is poorly understood. Here we report that translokin, a microtubule-associated protein, interacts with cyclin D1 and controls its nucleocytoplasmic distribution in quiescent cells. Translokin binds to regions of cyclin D1 also involved in binding to Cdk4, and both Cdk4 and translokin compete for binding to cyclin D1. Accordingly, while the interaction efficiency between cyclin D1 and translokin increases, the level of cyclin D1 in Cdk4 complexes decreases in quiescent cells. Downregulation of translokin levels results in undue nuclear accumulation of cyclin D1 and increased Cdk4-dependent phosphorylation of pRB under quiescence conditions. In turn, overexpression of translokin prevents proper cyclin D1 accumulation in the nucleus of proliferating cells in an interaction-dependent manner. We propose that translokin acts as a key negative regulator in the pathway that drives nuclear import of cyclin D1, thus contributing to prevent pRb inactivation and to maintain cellular quiescence.This work was funded by the Ministry of Education and Science of Spain, Consolider-Ingenio 2010, Fundació La Caixa, and the European Union (FEDER). N. C. is a researcher of the Ramón y Cajal programme. M. R.-M. and R. M. H. F. received fellowships from the Ministry of Education and Science of Spain.Peer Reviewe